II. Pathophysiology

  1. Air continues to accumulate in pleural space, but cannot escape

III. Symptoms

  1. Sudden sharp Chest Pain
  2. Air Hunger

IV. Signs

  1. Unilateral absent breath sounds
  2. Hyperresonant chest to percussion
  3. Cyanosis
  4. Respiratory distress
  5. Tachycardia
  6. Hypotension
  7. Tracheal deviation to contralateral side
  8. Neck vein distention

V. Imaging

  1. Bedside Ultrasound
    1. See Lung Ultrasound for Pneumothorax
  2. Chest XRay
    1. Do not use XRay to diagnose a Tension Pneumothorax
    2. Confirm diagnosis by Chest XRay after decompression

VI. Differential Diagnosis

VII. Precautions

  1. Tension Pneumothorax is a clinical diagnosis (not an imaging diagnosis)
  2. Do not obtain a Chest XRay prior to needle decompression (delays are lethal)
  3. Needle decompression buys a small amount of time in which to place a Chest Tube for definitive management

VIII. Management

  1. Emergent Needle Thoracentesis
    1. Do not wait for Chest XRay
    2. Use 14 gauge (5 cm long) angiocatheter in children and 10 gauge (7.5 cm long) angiocatheter in adults
    3. Insert angiocatheter over the top of the third rib in the mid-clavicular line
  2. Chest Tube
    1. Perform immediately after needle decompression
    2. Insert over the top of the 5th rib in the mid-axillary line

IX. References

  1. (2012) ATLS 9th ed, American College of Surgeons, Committee on Trauma, p. 96-9

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